Background: Older adults with cancer are a heterogeneous population at risk of under- and over-treatment.1,2 Geriatric assessment (GA) detects vulnerabilities and improves clinical outcomes.3-5 International guidelines recommend GA to inform care and treatment decisions at the time of cancer diagnosis.6-10
Objectives: This study aimed to audit the frequency of frailty and falls assessment in older adults with cancer at the Northern Beaches Hospital (NBH) oncology clinic and evaluate implementation of a frailty and falls screening tool. Secondary objectives included auditing screening for other domains: activities of daily living (ADLs), social situation, comorbidities, medications, cognition and nutrition. The hypothesis was routine assessments were lacking and could be improved with a screening tool.
Methods: A single-centre study was conducted at NBH oncology clinic (October 2022 - September 2024) with four components: 1. Retrospective record review auditing assessment of geriatric domains for new patients aged ≥ 65 years, 2. Implementation of a Frailty and Falls Screening Tool (VES-13 plus falls question) for six months, 3. Repeat retrospective record review, 4. Post-implementation survey of oncologists.
Results: The first and second audits reviewed 83 and 79 records respectively. Frailty or performance status (PS) documentation improved from 57.8% to 72.2% during the six months of screening tool implementation (p=0.056). PS tool documentation remained unchanged, with Eastern Cooperative Oncology Group PS being the most documented tool. Falls history documentation improved significantly (4.8% to 26.6%, p=0.0001), as well as documentation of number of falls (1.2% to 21.5%, p=0.00004). Mobility and ADLs documentation improved from 46.9% to 64.6% (p=0.025), and 65.1% to 83.5% (p=0.007) respectively. Oncologists found the tool useful but cited time and resource constraints as key barriers to GA.
Conclusion: This study demonstrates a practical, low resource approach to enhancing GA in oncology clinics. However, additional resources are needed to influence treatment decisions and patient outcomes.